Assessing the Gap: SIS Guidelines vs. Real-World Antibiotic Use in Facial Fractures

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Authors:
Ahmad El Nouiri, Hadi Hamdan, Jeffrey Johnson

Body of Abstract:
Introduction:
Facial fractures account for over 400,000 ED visits annually in the United States. They are managed operatively (open reduction and internal fixation, ORIF), non-operatively (closed reduction), or via observation with diet and activity modification. Regardless of management, antibiotics are commonly prescribed. The Surgical Infection Society (SIS) published 2020 guidelines advocating against antibiotic use in all pre- and post-operative as well as non-operative cases (upper face, mid-face, or mandibular).
Methodology:
This retrospective chart review evaluates antibiotic prescribing practices at a quaternary regional academic level one trauma center for patients with isolated facial fractures. It assesses potential antibiotic days saved by adhering to SIS guidelines. Data for all admitted patients above 18 presenting to Henry Ford Hospital’s trauma service with a facial fracture from January 2019 to August 2024 were acquired from the trauma registry. Patients were manually screened to ensure eligibility. Patients with clear antibiotic indications (e.g., open fractures, complex lacerations) were excluded. Antibiotic timing classification followed SIS guidelines: pre-op (>1 hour before surgery), peri-op (within 1 hour before surgery to 24 hours after), and post-op (>24 hours after surgery). Statistical analysis included descriptive methods for quantitative variables and Chi-Square for qualitative variables.
Results:
A total of 119 patients fit the criteria. 89.1% received antibiotics, with 57.6% receiving at least two. 80.2% of the antibiotics given were against the recommendations of the SIS. Total antibiotic days were 584. Mandibular (49.6%) and midface (41.2%) fractures were most common. The antibiotic administration rate for mandibular fractures was 98.3%. Operative management accounted for 93.2% of cases, mostly open. Antibiotic use did not significantly differ between operative and non-operative management (p=0.18). The rate of antibiotic use between open and closed operative management did not differ significantly either (p=0.99). Cephalosporins and Penicillins were most prescribed. Peri-op antibiotics were used in 89.9% of cases, but non-guideline operative use (pre and post-op) rates were 47.5% and 63.6%, respectively. No significant association existed between guideline publishing and non-guideline use (p=0.60). Surgical site infection and Clostridium Difficile complication rates were 0%.
Conclusion:
There is a clear discordance between antibiotic prescribing practices at our institution and the SIS guideline recommendations for facial fractures. Implementing guidelines could yield substantial cost savings and is vital in combating antibiotic resistance.

Are Fewer Damage Control Laparotomies Associated with a Decrease in the Rate and Severity of Surgical Site Infections?

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Authors:
Chelsea Guy Frank, John A. Harvin, Lillian S Kao, Renee W, Green, Stephanie Martinez Ugarte

Body of Abstract:
Background: Local damage control laparotomy (DCL) rates have decreased since the implementation of a multi-faceted quality improvement intervention during the first half of the last decade. Given the association of DCL with both organ space and incisional surgical site infections (SSIs), we hypothesize that SSI rates and severity based on Clavien-Dindo (CD) classification have decreased over the same time period.

Methods: A retrospective study was performed of all patients (>16 years) who underwent trauma laparotomy at a large metropolitan Level 1 Trauma Center from 01/2011-12/2020. Patients who did not survive >48 hours were excluded. The data was divided into period 1 (1/2011-12/2015) and period 2 (1/2016-12/2020). The Center for Disease Control and Prevention definitions of organ space (OS-SSI) and superficial and deep incisional (SD-SSIs) were used. CD classification was further grouped into minor and major, with CD grade 1 (opening the wound) and 2 (antibiotics) considered minor and CD grade ≥ 3a (procedure requiring sedation, single and multiorgan failure, and death) considered major. Univariate and multivariable analyses were performed (p<0.05). Results: Of 1975 patients that met inclusion criteria, the median age was 33 (23, 46) years old. A total of 18% (355) of patients developed an SSI, 18.5% (179) in period 1 and 17.4% (176) in period 2 (P= 0.5). Between periods 1 and 2, there was an increase in injury severity score (ISS, 19 [ IQR 10, 29] vs 21 [IQR 12, 34], P<0.001) and penetrating mechanism of injury (426 (44%) vs. 513 (51%), p=0.002), while there was a decrease in the use of DCL (283 [29%] vs. 153 [15%], P=0.001). Despite the decrease in use of DCL, the rates and severity of SSIs remained stable between the two time periods (Table). Length of hospital stay decreased (LOS, 10 [IQR 6,21] vs 9.5 [IQR 5, 20] P= 0.04). On multivariable analysis, DCL, penetrating mechanism of injury, lower emergency room systolic blood pressure, higher wound classification, large bowel resection, and splenectomy were predictors of CD grade ≥3a SSIs. Conclusions: Contrary to our hypothesis, despite decreases in DCL use, the rates and severity of SSIs after trauma laparotomy in our patient population have not decreased but remained stable over the recent decade. The decreased use of DCLs may have been offset by the increase in penetrating injuries. Other potentially modifiable risk factors need to be identified to be able to impact the frequency and severity of SSIs after trauma laparotomy.

Retained Hemothorax and Empyema After Trauma: Predictive Factors and Cost

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Authors:
Benjamin Stocker, Briana Britton, Daniel VanDerPloeg, Dante Yeh, Eric Campion, Ernest Moore, Fredric M Pieracci, Kassandra Samuel, Mandi Roberts, Renaldo Williams

Body of Abstract:
Background: Thoracostomy tubes (TT) placed for traumatic hemothorax can be complicated by retained hemothorax (rHTX) with a recorded incidence ~20%, and rHTX may lead to complications including empyema. Secondary interventions to treat rHTX include additional TT, instillation of lytic agents (tPA), and operative intervention (thoracoscopy or thoracotomy). The purpose of this quality improvement project was to review our institution’s incidence and consequences of rHTX and identify opportunities for improvement.
Methods: This retrospective, single-center study from Jan 2021 to Dec 2023 included adult trauma patients receiving TT for hemothorax. Patients were excluded if: non-survivable injuries on arrival, died or transitioned to comfort care within 48 hours, bilateral TT, TT placed at an outside institution or in the operating room during thoracic procedure, TT for pneumothorax only, video-assisted thoracoscopic surgery (VATS) for rib fixation, and VATS or thoracotomy within 6 hours of arrival. rHTX was defined as residual pleural blood on subsequent imaging after TT or dictated as an intraoperative finding. Data collected included demographics, TT-specific details, hospital charges, and clinical outcomes. Subjects were divided into two groups based on the presence/absence of rHTX and group characteristics and outcomes were compared. We additionally divided patients into thoracic irrigation vs. no thoracic irrigation and compared rHTX incidence.
Results: A total 113 patients were included, of whom 30 (27%) developed rHTX (Table. The majority of TT were placed for hemopneumothorax (68%) and placed in the Emergency Department (67%). Univariate analysis did not identify any predictive factors for rHTX. All rHTX patients required additional intervention, most commonly VATS, which was performed in two-thirds of rHTX patients. Three patients received tPA and two required additional TT. Thoracotomy (3%) and empyema (2%) were overall rare. However, patients with a rHTX had a trend towards more commonly developing an empyema (7% vs. 0%, p=.069). rHTX patients had significantly longer hospital length of stay (13 [6-24] vs. 8 [4-15] days, p=.044), and total hospital charges were higher for the rHTX group ($231K vs. $167K USD, p=.056), though not statistically significant due to sample size. Thoracic irrigation was uncommon (n=19; 17% overall) and the difference between rHTX and no rHTX groups was not statistically significant (10% vs. 19%, p=.393). When comparing patients receiving thoracic irrigation (n=19) vs. no thoracic irrigation (n=94), the rate of rHTX was 16% vs. 29%, respectively (p=.393).
Conclusions: At our institution, the rate of retained hemothorax is higher (27%) than published rates in the literature (~20%), and the incremental cost of retained hemothorax is approximately $64,500 USD. Thoracic irrigation utilization is low and routine implementation may be considered to decrease the rate of retained hemothorax in a cost-effective manner.

Readability of Infection-Related Patient Education Materials

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Authors:
Krislynn Mueck, Lillian S Kao, Parker Towns, Stephanie Martinez Ugarte, William Rieger

Body of Abstract:
Background: Patient education materials (PEMs) are intended to increase patient understanding of their condition and to reduce readmissions. To maximize accessibility, PEMs should be readable at a grade level of 6 or below. Little information is available on the variation of PEMs across hospital types or infectious conditions. We hypothesize that the mean readability of infection-related PEMs does not meet the goal grade level of 6 or below.
Methods: PEMs were obtained from a tertiary referral center and a safety net hospital by searching existing electronic medical record-linked repositories with key words related to nosocomial infections: “infection,” “surgical site infection,” “urinary tract infection,” “pneumonia,” and “central line associate blood stream infection.” PEMs that did not explain the definition, prevention, or treatment of infections were excluded. Each PEM’s readability was assessed with 3 well-validated measures: Flesch Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and FORd-CAylor-STicht (FORCAST); each is based on a separate syntactical formula with lower grades indicating a text is easier to read. These measures were compared across hospitals systems, readability measure, and infection type. Descriptive analysis, univariate, and multivariable analysis were performed.
Results: Of 91 PEMs, 49 (53%) were from the safety net hospital; 13 (14%) focused on SSIs and 11 (12%) were designated as “easy to read” from the safety net hospital. The mean readability grade level for infection-related PEMS across all measures was 8.3 (SD 2.12) though using the FKGL measure alone demonstrated a lower median readability level of 5.8 (IQR 5.64-5.96). The different readability measures differed significantly in their scoring (X2 of 197, p<0.001), with the FKGL estimating the lowest grade level in 2-way and 3-way comparisons (p<0.001). “Easy-to-read” PEMs had a lower mean readability score of 7.2 (SD 2.05), compared to others at 8.46 (SD 2.05). PEMs from the tertiary referral center and safety net hospital demonstrated similar mean readability scores with a median of 8.35 (SD 1.99) and 8.26 (SD 2.23), respectively without a significant difference (t= -0.36, 95% CI -0.6 – 0.33, p=0.361). Conclusion: The readability of infection-related PEMs was similar across hospital settings and specific infections but differed based on assessment tool used. Although "easy-to-read" PEMs had lower readability grade level scores, consistent with their label, opportunity still exists across all infection-related PEMs for improvement. Further study is needed to determine if improving the readability of infection-related PEMs is associated with better understanding among patients with low health literacy.

Is mobility after trauma laparotomy associated with surgical site infections?

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Authors:
Lillian S Kao, Mokunfayo Fajemisin, Renee W, Green, Stephanie Martinez Ugarte, William Rieger

Body of Abstract:
Background:
Traumatic injury can drastically affect mobility in patients, regardless of surgical intervention. Enhanced Recovery After Surgery (ERAS) protocols that include early mobilization after elective and emergency surgery have shown a decrease in surgical site infections (SSIs). Although only certain ERAS components are applicable to emergency surgery, early mobilization may be feasible. However, few studies have explored the existing prevalence of early mobilization after emergency trauma laparotomy or explored the association between physical mobility and SSIs. We hypothesized that degree of post-laparotomy, as denoted by the Activity Measure for Post-Acute Care (AMPAC) score, and time to mobilization, are associated with lower SSI rates in trauma patients.

Methods:
A retrospective analysis of adults (>16 years old) who underwent trauma laparotomy from 6/2022 – 6/2023 was performed. Patients who died without or never received physical therapy (PT) were excluded. Patient demographics, hospitalization details, SSI status per Centers for Disease Control guidelines, and inpatient PT details of days to mobilization, as denoted by PT initiation, and AMPAC scores at first post-operative PT session were collected from the medical record. AMPAC scores are derived from 6 activities of daily living scored 1-4 for a max of 24 meaning full function. Descriptive statistics, univariate, and multivariable analysis were performed using known SSI-associated factors.

Results:
Of 160 patients, 120 were male (75.5%), their median age was 34 (IQR 23-45) with a median injury severity score of 22 (IQR 12-32). Their median AMPAC score was 16 (IQR 9-24) and median time to mobility was 2 days (IQR 0-4) (Table). Seventeen (11%) patients had an SSI. Univariate regression showed no significant association between initial AMPAC scores and SSIs (OR 1.0, 95% CI 0.91-1.09, p=0.93), but time to mobilization was significantly associated (OR 0.93, 95% CI 0.91-1.09, p=0.01). In separate models, each adjusted for injury severity score, AMPAC scores were not associated with SSIs (OR 1.0, 95% 0.88-1.10, p=0.85), while days to mobilization remained significantly associated (OR 1.04, 95% CI 0.94-1.02, p<0.01). Conclusions: This single center analysis showed that time to initial mobilization but not initial physical function per AMPAC scores was associated with SSI. While multiple confounders may impact these metrics, the data suggest an opportunity for earlier patient mobilization after emergency trauma laparotomy, potentially as a component of an ERAS protocol.

Malnutrition in Emergency General Surgery Patients: Does Its Impact Differ by Procedural Risk Level?

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Authors:
Barbara Okafor, Joaquim Havens, Manuel Castillo-Angeles, Rebecca Wiener, Reza Askari, Stephanie Nitzschke

Body of Abstract:
Background: Malnutrition is a critical factor influencing patient outcomes following emergency general surgery (EGS). It is associated with increased morbidity, prolonged hospital stays, and higher healthcare costs. Understanding the extent and impact of malnutrition can inform strategies to improve surgical outcomes and patient recovery. Therefore, our goal was to determine if the increased burden of morbidity and mortality of malnutrition in EGS patients varies based on the level of procedural risk.

Methods: The Nationwide Inpatient Sample (2015-2018) was queried to identify adult patients that underwent one of 7 previously described EGS procedures. These were stratified as high-risk (excision of large intestine, excision of small intestine, surgical treatment of ulcer of stomach or duodenum, lysis of peritoneal adhesions and laparotomy) and low-risk (appendectomy and cholecystectomy). Malnutrition was defined using ICD-10 Diagnosis codes. Our main outcome was in-hospital mortality. Multivariable logistic regression analysis was used to determine the association between malnutrition and mortality, and subsequently, this was stratified by procedural risk level.

Results: A weighted total of 3,493,853 EGS admissions were identified. Mean age was 53.64 (SD 20.71), 43.76% were male and 66.51% were white. Overall mortality was 2.33%. Malnutrition was found in 278,175 (7.96%) EGS patients and mortality within this group was 8.27%. High-risk procedures represented 55.32% of the total EGS population. After adjusting for demographic and clinical characteristics, malnutrition was an independent predictor of mortality (Odds Ratio [OR] 3.07, 95% Confidence Interval [CI] 2.94 – 3.20). After stratified analysis, this association remained significant for high-risk procedures (OR 2.34, 95% CI 2.24 – 2.44) and it was stronger within low-risk procedures (OR 5.82, 95% CI 4.96 – 6.83).

Conclusion: Malnutrition was significantly associated with mortality in patients undergoing EGS, with an even greater association in low-risk procedures. These findings support that preoperative assessment, and screening should be applied universally because even low-risk procedures may represent a high risk among patients who are malnourished.

Outcomes and Predictors of Fungal Necrotizing Soft Tissue Infections

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Authors:
Anahita Jalilvand, Bradley Butsch, Courtney Collins, George Abboud, Jonathan Wisler, Patrick Quinn, Shachi Srivatsa

Body of Abstract:
Background: The treatment of necrotizing soft tissue infections (NSTIs) relies heavily on early antibiotic initiation and surgical debridement. While rare, fungal NSTIs are often difficult to diagnose. We sought to better understand outcomes, treatment patterns, and predictors in fungal necrotizing soft tissue infections.

Methods: Retrospective analysis of institutional data for patients diagnosed with NSTIs was performed (n = 634; 2011-2023). Patients were stratified by the presence of fungi in the wound culture. Abstracted patient characteristics included demographics, comorbidities, treatments received, and hospitalization outcomes. Primary outcomes included mortality, length of stay, intensive care requirements, acute kidney injury, and 30-day readmission. Logistic regression was used to identify potential predictors of fungal infection.

Results: Of 634 patients, 110 (17.4%) had fungal-positive wound cultures and 524 (82.6%) did not. Patients with fungal NSTIs were more likely to have type two diabetes mellitus (74.5% vs. 61.6%, p=0.014). There was no difference between cohorts in the incidence of sepsis, APACHE II score, or SOFA score. Of those with positive fungal cultures, candida albicans was the most common (47.3%) followed by the grouping of other candida types including galbrata, parapsilosis, and auris (44.5%). The most common antifungal antibiotics used were fluconazole (35.5%) and caspofungin (32.7%). The median time from wound culture to therapy administration was 3 (IQR 2, 5) days and the median time from wound culture to culture result was 2 (IQR 2,5) days. Only 12 patients (10.9%) received empiric antifungal therapy. Regarding hospital course, patients with positive fungal wound cultures were more likely to require two or more operative debridement (p < 0.001), had a higher total length of stay (19 vs. 12 days, p < 0.001), require mechanical ventilation (p < 0.001), and had higher 30-day (9.9% vs 18.2%, p = 0.01) and 90-day mortality (12% vs 20%, p = 0.038). Patients with polymicrobial cultures positive for fungi and clostridial species had the highest 90-day mortality rate (38%). Diabetes mellitus was an independent predictor of developing a fungal NSTI (odds ratio 2.11, 95% CI 1.27 – 3.49, p = 0.004). Conclusion: Fungal NSTI infections were associated with higher rates of 30-day and 90-day mortality with more complex hospital courses than those without fungi. Diabetes mellitus was an independent predictor for fungal NSTI. Very few patients received empiric anti-fungal therapy and on average anti-fungal therapy was not initiated until three days after fungal infection was present. Our data suggests that empiric anti-fungal therapy should be considered in patients who are critically ill with an NSTI, especially those with known diabetes. The high incidence of azole-resistant candida species (galbrata, parapsilosis/auris) in our patients suggests that caspofungin is a more appropriate empiric therapy than fluconazole.

Intensive time travel: Clinical characteristics of early and late bronchoscopic cultures in intubated medical and surgical ICU patients

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Authors:
Alyssa Douville, Brett Fair, Christopher Merrick, Emily Johnson, Kailee Severt, L. Paige Clement, Nathan Schmoekel, Savannah Gross, Srishti Singal, Thomas Schroeppel

Body of Abstract:
Introduction
Pneumonia is a leading cause of morbidity and mortality in ICU patients. Organisms associated with pneumonia and outcomes vary according to duration of mechanical ventilation (MV), length of stay (LOS), antimicrobial exposure, and local ecology. Objectives of this study are to define organisms and outcomes of early and late bronchoscopy with cultures (bronch) in intubated patients in a mixed ICU setting. Surgical/trauma (SICU) and medical ICU (MICU) teams treat unique patient populations. We hypothesize patient demographics are more predictive of causative organism and outcomes in early and late bronch rather than physical care environment.
Methods
A retrospective comparison of SICU and MICU patients who received bronch with either bronchial alveolar lavage (BAL) or bronchial washings between 1/1/2022 and 12/31/2023 was performed at a level-1 trauma center in a mixed ICU. Exclusion criteria were withdrawal of life-sustaining therapy or another service performing bronch. Variables collected include demographics, hospital and ICU LOS, mortality, MV duration prior to bronch, isolated pathogens, and duration of therapy. Early bronch was defined as ≤ 7 days with late as > 7 days. Categorical variables were analyzed with Chi square or Fisher’s exact test and continuous variables were analyzed with Student’s t-test or Wilcoxon rank sum based on data distribution.
Results
161 patients were identified during the study period, 102 patients with early bronch and 59 with late. Normal flora was most commonly identified in both patient populations in both early and late groups (46.8 MICU vs 71.4% SICU for all bronch, p=0.001). Compared with MICU, the SICU population was younger, but there were no other differences in sex or duration of MV prior to bronch (Table). There were no differences in multidrug resistant organisms (MDRO), extended-spectrum beta-lactamases (ESBL), the presence of gram-negative (GN), or gram-positive (GP) organisms in early or late bronch. MICU patients were more likely to have fungal organisms present in both early and late groups which was most commonly Candida sp. SICU patients were more likely to grow H. influenzae in early bronch (2.3 vs 17.2%, p=0.022) and Methicillin-sensitive S. aureus in late (0 vs 15.4%, p=0.033). MICU patients received a longer duration of antimicrobial therapy (7 vs 5 days, p=0.0006), but had a shorter hospital LOS (25 vs 32 days, p=0.031) and higher in-hospital mortality (15.6 vs 3.6%, p=0.013).
Conclusion
The organisms identified in early and late bronch as well as duration of therapy differed by primary team in a mixed ICU setting. MICU and SICU patients are inherently different due to the nature of their presentations and etiology of their illness and/or injury. Antibiograms should be based on patient population and not unit location in a mixed ICU setting.

The Impact of Type of Immunosuppressive Medication in Necrotizing Soft Tissue Infections

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The Impact of Type of Immunosuppressive Medication in Necrotizing Soft Tissue Infections

Authors:
Manuel Castillo-Angeles, Avery Thompson, Reza Askari

Body of Abstract:
Background: Necrotizing soft tissue infections (NSTIs) are a group of uncommon but rapidly progressive bacterial infections with high morbidity and mortality. Prior research has shown that NSTI patients with immunocompromised status are at increased risk of delayed diagnosis and worse overall outcomes. However, It is uncertain if variation exists across different immunosuppressive medications. Our objective was to determine the impact of immunosuppression type on mortality and morbidity in patients with NSTI.

 

Methods: This was a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database from 2021-2023. We included all adult patients with a diagnosis of NSTI, defined by ICD-10 Diagnosis codes for necrotizing fasciitis, gas gangrene, and Fournier’s gangrene. Immunosuppression therapy was defined as regular administration of oral or parenteral corticosteroids, anti-rejection/transplant immunosuppressants, synthetic or biologic Disease-Modifying Antirheumatic Drugs (DMARDs)/Disease-modifying drugs (DMDs), others, or combinations of the described medications within 30 days of the operative procedure. The primary outcomes were overall mortality and readmission within 30 days. Multivariate logistic regression was used to determine the association between immunosuppression type and main outcomes.

 

Results: A total of 2,480 NSTI patients were included, of which 151 (6.09%) received immunosuppressive therapy (41% received corticosteroids, 3.9% anti-rejection/transplant immunosuppressants, 10% synthetic, and 14% biologic DMARDs/DMDs). Mean age was 56.3 (SD 13.1) years, 30.5% were female, and 68.7% were White. Overall mortality was 9.5% for the entire cohort and 17.8% within the immunosuppressed group. After adjusting for clinical and demographic variables, immunosuppressive therapy was significantly associated with higher mortality (Odds Ratio [OR] 2.15, 95% Confidence Interval [CI] 1.01 – 4.57), driven by those receiving biologic DMARDs/DMDs (OR 7.10, 95% CI 1.20 – 14.19). It was also associated with higher odds of readmission (OR 2.37, 95% CI 1.21 – 4.63), particularly those receiving a combination of immunosuppressive medications (OR 4.43, 95% CI 1.55 – 12.62). 

 

Conclusions: Immunosuppression was significantly associated with worse mortality and readmission in NSTI patients. These associations were mainly driven by those patients receiving biologic DMARDs/DMDs and a combination of immunosuppressive medications, respectively. These results underscore the need for targeted updates to both preoperative and postoperative protocols to prevent complications in the NSTI population.

The Role of Adipokines in Mediating Immuno-metabolic Crosstalk in Burn Sepsis

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The Role of Adipokines in Mediating Immuno-metabolic Crosstalk in Burn Sepsis

Authors:
Stephanie Wojtowicz-Piotrowski, Ghazaleh Dadashizadeh, Marc G. Jeschke

Body of Abstract:
Background: As the leading cause of mortality in burn injury, burn-induced sepsis drives extensive metabolic and immune dysregulation. However, how these metabolic and inflammatory pathways interact to shape disease progression remains unknown. Adipokines, signalling molecules released from adipose tissue, are essential for functional metabolism, and control processes such as inflammation, insulin sensitivity and energy homeostasis in the adipose tissue and distant organs. Emerging evidence suggests that these molecules interact closely with pro- and anti-inflammatory cytokines and can influence the progression of sepsis in non-burn-related contexts. However, it is unknown whether similar adipokine-cytokine interactions contribute to the pathophysiology of sepsis post-burn. Therefore, this study aims to identify whether such interactions exist in burn-induced sepsis.

Methods: Serum samples from non-septic and septic adult burn patients were analyzed using ELISA to quantify circulating levels of the adipokines leptin (LEP), adiponectin (ADIPOQ), and resistin (RETN). Cytokine profiles corresponding to the same patients were analyzed using Multiplex assays. Spearman correlation analyses were then performed to determine associations between adipokine and cytokine levels within non-septic and septic burn patient groups.

Results: Circulating adipokine profiles differed significantly between septic and non-septic burn patients. Serum LEP (p < 0.001) and RETN (p < 0.05) were significantly elevated, whereas ADIPOQ was significantly reduced (p < 0.05) in septic burn patients. In Spearman rank correlation analyses, surprisingly, neither LEP nor ADIPOQ demonstrated meaningful associations with any cytokines. Remarkably, however, RETN exhibited significant, positive correlations with nine different cytokines exclusively in septic burn patients: interleukin-10 (IL-10; rs=0.8929, p=0.01), IL-6 (rs=1, p=0.0004), granulocyte colony-stimulating factor (G-CSF; rs=0.8214, p=0.03), granulocyte-macrophage colony-stimulating factor (GM-CSF; rs=0.8857, p=0.03), IL-15 (rs =0.9643, p=0.003), IL-17 (rs=0.8571, p=0.02), IL-7, (rs=0.9643, p=0.003), IL-8 (rs=0.8571, p=0.02), and monocyte chemoattractant protein-1 (MCP-1; rs=0.8571, p=0.02). Conclusions: Here, our findings reveal RETN as a uniquely activated metabolic-immune signal in burn-induced sepsis. Unlike LEP or ADIPOQ, RETN demonstrated strong, sepsis-specific correlations with a broad network of pro- and anti-inflammatory cytokines, highlighting its potential mechanistic link between metabolic dysfunction and immune dysregulation after severe burn injury. Considering the diagnostic potential of cytokines in sepsis, the magnitude of these associations underscores the promise of RETN as both a potential diagnostic marker and therapeutic target. By uncovering this previously unrecognized adipokine-cytokine axis in burn sepsis, this study opens new avenues for targeted modulation of sepsis in burn patients.